title: Home blood pressure measurement as a screening tool for hypertension in a web-based worksite health promotion programme.
abstract: BACKGROUND
  Guidelines on home blood pressure measurement (HBPM) recommend taking at least 12 measurements. For screening purposes, however, it is preferred to reduce this number. We therefore derived and validated cut-off values to determine hypertension status after the first duplicate reading of a HBPM series in a web-based worksite health promotion programme.
  
  
  METHODS
  Nine hundred forty-five employees were included in the derivation and 528 in the validation cohort, which was divided into a normal (n = 297) and increased cardiometabolic risk subgroup (n = 231), and a subgroup with a history of hypertension (n = 98). Six duplicate home measurements were collected during three consecutive days. Systolic and diastolic readings at the first duplicate measurement were used as predictors for hypertension in a multivariate logistic model. Cut-off values were determined using receiver operating characteristics analysis.
  
  
  RESULTS
  Upper (≥ 150 or ≥ 95 mmHg) and lower limit (<135 and <80 mmHg) cut-off values were derived to confirm or reject presence of hypertension after one duplicate reading. The area under the curve was 0.94 (standard error 0.01, 95% confidence interval 0.93-0.95). In 62.5% of participants, hypertension status was determined, with 1.1% false positive and 4.7% false negatives. Performance was similar in participants with high and low cardiometabolic risk, but worse in participants with a history of hypertension (10.4% false negatives).
  
  
  CONCLUSIONS
  One duplicate home reading is sufficient to accurately assess hypertension status in 62.5% of participants, leaving 37.5% in which the whole HBPM series needs to be completed. HBPM can thus be reliably used as screening tool for hypertension in a working population.
authors.affiliation: 1 NIPED Research Foundation, Amsterdam, The Netherlands.
authors.forename: Maurice A J
authors.initials: MA
authors.lastname: Niessen
authors.affiliation: 1 NIPED Research Foundation, Amsterdam, The Netherlands 2 Departments of Internal and Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands n.v.vanderhoeven@amc.nl.
authors.forename: Niels V
authors.initials: NV
authors.lastname: van der Hoeven
authors.affiliation: 2 Departments of Internal and Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Bert-Jan H
authors.initials: BJ
authors.lastname: van den Born
authors.affiliation: 1 NIPED Research Foundation, Amsterdam, The Netherlands.
authors.forename: Coen K
authors.initials: CK
authors.lastname: van Kalken
authors.affiliation: 1 NIPED Research Foundation, Amsterdam, The Netherlands.
authors.forename: Roderik A
authors.initials: RA
authors.lastname: Kraaijenhagen
mesh_terms: D019540:Area Under Curve; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000295:instrumentation / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D020407:Internet; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015397:Program Evaluation / Q000379:methods*; D015203:Reproducibility of Results; D012648:Self Care / Q000379:methods*; D017132:Workplace